Thursday, March 18, 2010

Topaz Procedure

Question: Our surgeon excised a portion of the patient’s Achilles tendon, reanastomosed the tendon using running sutures, and then used the TOPAZ procedure to augment the repair. The patient’s tendon wasn’t torn or ruptured. How should we code this procedure?

Answer: Because the tendon in this case isn’t torn or ruptured, you should report 27680 (Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon). CPT includes several codes for Achilles tendon repair, so know how to differentiate them according to your case. Keep these guidelines from the American Orthopaedic Foot and Ankle Society (AOFAS) in mind:
• For debridement of insertional Achilles tendinitis and repair (suture anchor versus bony trough), choose code 27680.
• For Achilles tendon debridement and repair for tendonosis, choose 27654 (Repair, secondary, Achilles tendon, with or without graft).
• For Achilles tendon debridement with FHL transfer and tenodesis FHL to FDL, choose 27680 and 27691 (Transfer or transplant of single tendon [with muscle redirection or rerouting]; deep [e.g., anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot).
• For repair of the Achilles tendon to calcaneus for traumatic avulsion, choose 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon).
Definition: TOPAZ is a new micro-ablator technique for soft tissue procedures. According to CPT Assistant, consider the TOPAZ as any other technique and code accordingly — by choosing the most accurate code from the above list.

Ulnar Impaction Syndrome Dx

Ulnar Impaction Syndrome Diagnosis
The best choice is 718.83 (Unspecified derangement of joint; forearm) to represent instability.
The most common surgical options to treat ulnar impaction syndrome (after physical therapy or other modalities have failed) include an ulnar shortening osteotomy (25390, Osteoplasty, radius or ulna; shortening) and hemiresection arthroplasty (25442, Arthroplasty with prosthetic replacement; distal ulna). Depending on the situation, your surgeon might perform resection of the distal ulna (25240, Excision distal ulna partial or complete [e.g., Durrach type or matched resection]) or an arthroscopic wafer procedure (29999, Unlisted procedure, arthroscopy).

Ulnar impaction syndrome is also known as ulnar abutment syndrome, and can be a common complication after distal radial fracture. The term means the distal ulna is no longer in line with the distal radius, resulting in the ulna being longer. The ulnar weight bearing load increases and causes chronic pain on that side of the wrist

Orthopedic Newsletter Jan. 2010